Medicare Explained 2011 PDF (Adobe DRM) download by CCH Editorial Staff

Medicare Explained 2011

Aspen Publishers
Publication date: March 2011
ISBN: 9781454814191
Digital Book format: PDF (Adobe DRM)


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This book has been prepared for Medicare beneficiaries and others who need a relatively thorough explanation of the Medicare program with particular emphasis on services covered iin institutional settings and services provided by physicians and suppliers. Published annually, this book include changes made during 2010 by law and regulation amendments and updates to program manuals issued by the Centers for Medicare and Medicaid Services (CMS). The book includes analysis of legislative, regulatory and agency guidance issuance on the available benefits; exclusions from Medicare; the administration of the Medicare program; and Medicare payment rules under Parts A, B, C, and D. The book also details the process for submitting beneficiary claims as well as the appeals process.

Updates to this edition include:

  • New rules closing the prescription drug "donut hole"
  • Physician incentives for "meaningful use" of health information technology
  • Program for testing and certification of electronic health record technology
  • Creation of a new Center for Medicare and Medicaid Innovation
  • New CMS screening requirements before enrollment or renewal of providers
  • Coverage for prevention services, including an "annual wellness visit"
  • Expansion of the RAC program to include Medicare Part C and D plans
  • A new bundled, prospective payment system for outpatient dialysis
  • Information needed for development of the new Federally Qualified Health Center Prospective Payment System
  • The need for physicians to have face-to-face encounters with patients in order to certify the need for home health services, hospice, and orders for durable medical equipment
  • Replacement of the end-stage renal disease (ESRD) composite rate system with an ESRD prospective payment system
  • Reduction in the maximum time period for submission of Medicare fee-for-service claims
  • Future impact of health care reform beyond 2011

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